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The effect of pharyngeal structures on the severity of obstructive sleep apnea

  • Neurology • Original Article
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Abstract

Background/objective

Obstructive sleep apnea (OSA) is characterized by complete or partial cessation of breathing during sleep. The tongue is suggested as a possible anatomical site causing airway obstruction. However, the role of other pharyngeal structures in the development of OSA remains unclear. We designed a study using both the apnea–hypopnea index (AHI) and the oxygen saturation measurements to assess the severity of OSA. We aimed to identify critical anatomical structures of the upper airway that correlate with the severity of OSA and to evaluate the utility of magnetic resonance imaging (MRI) markers to detect possible OSA in patients without overt symptoms.

Materials and methods

The study included participants referred to the neurology outpatient clinic from the check-up unit. Participants were grouped as controls, mild, moderate, or severe OSA according to the AHI. A cranial MRI with a field of view (FOV) encompassing the upper airway structures was obtained from all participants. The areas of the tongue and the uvula were measured on the sagittal images by drawing the boundaries of the tissues manually. The posterior air space (PAS) area was evaluated from regions of interest in five parallel planes.

Results

Of 105 participants, 30 were controls, 27 had mild, 25 had moderate, and 23 had severe OSA. The moderate and severe OSA groups did not differ in oxygen saturation levels during sleep. Therefore, patients with moderate and severe OSA were combined into one group (moderate/severe OSA). The area of the tongue was significantly larger in the moderate/severe OSA group compared to the control group. Both the tongue and the uvula areas showed a significant positive correlation with the AHI.

Conclusion

Our findings suggest that the tongue and uvula have prominent roles in the severity of OSAS. It may be useful to measure these structures with MRI to screen for at-risk individuals without overt OSA symptoms.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Murat Aksu for his contributions to the editing of the manuscript.

Author information

Authors and Affiliations

  1. Electroneurophysiology Department, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Mustafa Emir Tavsanli

  2. Acibadem Taksim Hastanesi, İnönü Mah, Nizamiye Cad No 9/1, Sisli, Istanbul, Turkey

    Mustafa Emir Tavsanli

  3. Radiology Department, Acibadem Taksim Hospital, Istanbul, Turkey

    Amalya Zeynalova

  4. Department of Neurology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Mustafa Seckin

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  1. Mustafa Emir Tavsanli
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection were performed by MET and AZ, and analysis was performed by MET and MS. The first draft of the manuscript was written by MET, MS, and AZ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mustafa Emir Tavsanli.

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Ethics approval and consent to participate

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (Acibadem Mehmet Ali Aydinlar University Ethical Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors declare no competing interests.

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Tavsanli, M.E., Zeynalova, A. & Seckin, M. The effect of pharyngeal structures on the severity of obstructive sleep apnea. Sleep Breath (2023). https://doi.org/10.1007/s11325-023-02973-3

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  • DOI: https://doi.org/10.1007/s11325-023-02973-3

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